Kristine Marie Goulet, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

D12589 Issued in MN

Practice address

2467 15TH St NW
Suite a
New Brighton, MN 55112-5596

Phone

(651) 633-4883

NPI assigned

Dec 11, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dr My Pang Kou Vang DDS, PLLC

  • Dental Clinic/Center
  • New Brighton, MN
  • NPI 1174419923
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1197331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252886400000",
    "number": "1417130667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2467 15TH ST NW",
            "address_2": "SUITE A",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551125596",
            "telephone_number": "651-633-4883",
            "fax_number": "651-633-4998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2467 15TH ST NW",
            "address_2": "SUITE A",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551125596",
            "telephone_number": "651-633-4883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOULET",
        "first_name": "KRISTINE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-12-11",
        "last_updated": "2009-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.025038",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D12589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard John Goenner
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• Jacqueline Christine Golob
• Jennifer Gonzalez Rodriguez
• Goodness and Mercy Health Services Inc.
• Grace Home Care LLC
• Grace N' Care L.L.C
• Michael John Greeman, LICSW
• Leslie Ann Groome, L,P,C,C,
• Angela Helene Gross, RD

• Dentist in New Brighton, MN
• Providers in New Brighton, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.